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Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Signaty{e of oppl'c Address Application date 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans By Date Plans By Notes Fee Started Approved BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS ate Date Permit or Approval Check ObDtai ed Number By Permit or Approval Check Obtained Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER V11. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19)7 Building Fire Grading Permit Fee $ _ Live Loading Certificate of Occupancy $ Occupancy Load Approved by: Drain Tile $ �e�"�""T''� � • Plan Review Fee $ TITLE CITY OF NORTHAMPTON $. MASSACHUSETTS r • $ OFFICE of the INSPECTOR of BUILDINGS t Page 177 Plot 4Isr APPLICATION FOR ZONING PERMIT AND INSPECTOR BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. 0 ';;;---���' ZONING I• AT (LOCATION) / • le-b7�'� DISTRICT LOCATION (NO.) }— (STREET) OF BETWEEN y_%~ Y(`�. r _ AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D ;0 A. TYPE OF IMPROVEMENT D. PROPOSED USE - For-Wrecking" most recent use m m 1 ❑ New building Residential Nonresidential 2 © Addition(If residential, enter number 12❑ One family 18 ❑ Amusement, recreational Of new bousing units added, if any, in Part D, ]3) 13 ❑ Two or more family - Enter 19 ❑ Church, other religious number of units- - - - -i 20 ❑ Industrial 3 ❑ Alteration (See 2 above) 14 Transient motel,, ❑ Repair, replacement y - 21 �� Parking garage 4 or dormitory Enter number 5 El Wrecking (If multifamily residential, of units ------- - --� 22 �� Service station, repair garage enter number of units in building to 15 Garage 23 Hospital, institutional Part D, 13) 16 ❑ Carport � 24 Office, bank, professional 6 ❑ Moving (relocation) I-)+---r_ 17 ❑� Other - Specify ✓ 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School, library, other educational B. OWNERSHIP 27 ❑ Stores, mercantile 8 Private (individual, corporation, 28 ❑� Tanks, towers nonprofit institution, etc.) 29 ❑ Other - Specify 9 ❑ Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,•,•,,,....... 0 - school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. 7'o be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical..................... b. Plumbing ...................... c. Heating, air conditioning.......... d. Other (elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT is -0 C) III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30❑ Masonry (wall bearing) 40 ❑ Public or private company 48. Number of stories............... 31 Wood frame 41 ❑ Private (septic tank, etc.) 49. Total square feet of floor area, t all floors, based on exterior 32 ❑ Structural steel dimensions ..................... 33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLY 34 ❑ Other - Specify 42 ❑ Public or private company 50. Total land area, sq. ft. .......... 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 35 '❑ Gas Will there be central air 52. Outdoors........................ conditioning? �,/ L. RESIDENTIAL BUILDINGS ONLY 37 CJ Electricity 44 �] Yes 45 irNo 53. Number of bedrooms.............. 38 ❑ Coal 39❑ Other - Specify { �.��: Will there be an elevators Full.......... _ 54. Number of N o 46 Yes 47 bathrooms Partial........ DEPT. OF BUILDING INSPECTIONS BUILDING ZO 1 212 Main Street '< I IL Northampton, MA 01060 PERMIT 17C - 215 VALIDATION DATE July 23, 19 87 PERMIT NO. 485 APPLICANT Edward & Jean Gieryk ADDRESS Dep�7t. , Florence Owners (NQ.) (STREET) (CONTR•S LICENSE) PERMIT TO Addition STORY Deck NUMBER OF (_) DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) 1 Depot Street, Florence ZONING G8 AT (LOCATION) p DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: permit for the addition of a 10' x 10' deck AREA OR 100 sq. ft. 500.00 PERMIT 1 0.00 VOLUME ESTIMATED COST $ FEE $ (CUBIC/SQUARE FEET) OWNER Same as Applicant � � ,s ADDRESS Same as Aopl icant BYIL WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p'INT P